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About EINet
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Vol. VI, No. 08~ EINet News Briefs ~ May 9 , 2003
****A free service of the APEC Emerging Infections Network*****
The EINet listserv was created to foster discussion, networking, and collaboration in the area of emerging infectious diseases (EID's) among academicians, scientists, and policy makers in the Asia–Pacific region. We strongly encourage you to share their perspectives and experiences, as your participation directly contributes to the richness of the "electronic discussions" that occur. To respond to the listserv, use the reply function. In this edition:
1. OVERVIEW OF INFECTIOUS–DISEASE INFORMATION Below is a semi–monthly summary of Asia–Pacific emerging infectious diseases. ASIA Vietnam – Suspected Enterovirus, Childhood Deaths toll doubles
to reach 38 Doctors and medical experts, along with the WHO, completed an epidemiology
survey in Ho Chi Minh City on Apr. 15, 2003. They did not classify the illness
as an outbreak because the cases did not appear to be linked and were scattered
throughout many provinces, the newspaper said. All the children who died of
the disease experienced high fever and convulsion. Nearly 70 per cent of them
died within a day of becoming sick. Cambodia (Northeast) — Undiagnosed respiratory disease "There is no evidence that this outbreak is in any way linked to SARS," said the joint mission's report. But the bad news is doctors still don't know much more about the disease. "A spate of deaths like this caused by an illness we cannot determine by tests is unusual," said Dr. Severin Xylander, a German doctor and the only World Health Organization representative to visit the area. The village chief, doesn't care. He says he brought the disease under control
with rituals he conducted on Mar. 20, 2003, witnessed by about 200 villagers. "It
stopped tormenting us after the big ceremony. I know, because people stopped
dying and didn't get sick anymore," he said. Russia (Urals) — Flare of Diphtheria Closes School for Quarantine
in Nizhny Tagil All of the affected children had been vaccinated, leading Yelena Romashina,
chief doctor of the city's sanitary and epidemic monitoring service, to suggest
that it might be a new form of the disease
resistant to the existing vaccine. Cases of diphtheria have also been recorded
in other area schools and nurseries, as well as among some of the patients'
family members. WHO — Harm reduction is safe and effective Tom Moore of the World Health Organization (WHO) said that the harm reduction approach had gained support in several countries because, contrary to popular belief, this program was not only safe, but also effective and cost–effective in addressing the HIV/AIDS epidemic. "By 2000, the needle and syringe program in 103 cities across Australia had prevented 25,000 HIV infections and 21,000 HCV (Hepatitis C) infections. By 2010, it will have prevented 5,000 HIV–related deaths," and "An international review has reported the decrease of HIV prevalence by 5.8 percent in 29 cities with the program, and an increase of HIV prevalence by 5.9 percent in 52 cities without the program," he said. The harm reduction approach has been implemented in various degrees in areas
throughout Europe, Latin America, India, Southeast Asia and Australia. AMERICAS
Canada — Suspected human Anthrax on shipboard A cargo ship bound for a Quebec port will be intercepted by Canadian authorities, after it was learned that an officer on board died of the bacterial disease anthrax this week. The Wadi Al Arab, an Egyptian vessel carrying about 50,000 tons of bauxite to an Alcan aluminum plant in Saguenay, will be diverted to Halifax and inspected by Health Canada, Transport Canada, and the Royal Canadian Mounted Police for possible anthrax contamination. An Alcan spokesperson alerted health officials after being told by the crew
that the first mate had died from anthrax and had been left behind in Brazil.
By midnight April 26, the ship was over 300 nautical miles outside Canadian
waters, about a day's journey away. It will not be allowed into any other port
until shown to be disease–free. Canada (Ontario) — Infection of the West Nile Virus–positive
Crow Chile — Dengue Mosquito found for the first time "This is the first observation of the insect in the area since its eradication
at the beginning of the twentieth century," said Cecilia Perret, director
of the tropical diseases laboratory at the Catholic The National Office of Emergencies is distributing water in the Huasco Province,
which is known for its dryness. Due to the scarcity of water, the villagers
usually store water in containers that can facilitate the reproduction of the
mosquito. Mosquitoes typically breed in standing water, including rain water
that collects in old tires or containers. EUROPE
Netherlands, Belgium — Avian influenza and Vaccination The WHO Global Influenza Surveillance Network is currently assembling a test kit for H7N7 that will be ready for use in three weeks. As a precautionary measure, the network is also working on the development of a vaccine for H7N7. The European Commission has agreed recently to the vaccination of avian influenza (or AI) –susceptible birds in zoos. Based upon the Ministerial Decree, such vaccinations are allowed, provided some conditions are fulfilled: data on the vaccinated birds should be maintained for 10 years following the vaccination; results of their serological tests should be kept for 10 years; movement to other zoos is allowed only if officially supervised; and no products derived from such birds are allowed in the food chain. Reports concerning avian influenza from the Standing Committee on the Food
Chain and Animal Health and COMMISION DECISION of European Union concerning
protection measures in relation to avian influenza in Belgian are available
at the following site: http://www.favv.be/indexEN.htm EU— extends US poultry ban due to Newcastle disease All live poultry imports including hatching eggs, fresh poultry meat, and poultry products were now stopped from El Paso and Hudspeth counties in the US state of Texas and the counties of Dona Ana, Luna, and Otero in neighboring New Mexico. The confirmation of an outbreak of the virus in Texas on Apr. 11, 2003 had prompted the 15–nation block to extend its ban, the European Commission said. At the end of January 2003 the EU blocked poultry imports from California, Nevada, and Arizona after outbreaks of the disease in those states. The extended ban will now apply until Aug. 1, 2003. NCD can wipe out poultry populations and affects the birds' respiratory, nervous,
and digestive systems. It spreads primarily through direct contact between
healthy birds and the bodily discharges of infected birds. The virus is fatal
for fowl but harmless to humans. The last US outbreak was in 1971.
Multi Country Outbreak — Severe Acute Respiratory
Syndrome (SARS)
On May 7, 2003, the World Health Organization (WHO) has revised its initial estimates of the case fatality ratio of SARS based on an analysis of the latest data from Canada, China, Hong Kong SAR, Singapore, and Viet Nam. The overall estimate of case fatality is 14% to 15%, ranging 0% to 50% depending on the affected age group. WHO has also reviewed estimates of the incubation period SARS and then they conclude that the current best estimate of the maximum incubation period is 10 days. WHO continues to recommend the earliest possible isolation of all suspected and probable cases of SARS. According to new laboratory studies, the SARS virus can survive on common surfaces at room temperature for hours or even days. “This shows that transmission by contaminated hands or contaminated objects in the environment can play a role,” said Klaus Stohr, the WHO’s top scientist. He also said, “What we don’t know is the infectious dose.” As of May 7, 2003, a cumulative total of 6,903 SARS cases, 495 deaths, and 2885 recovered cases since November 1, 2002, are reported from the following countries (number of cases): Australia (4), Brazil (2), Canada (146), China (4560), Hong Kong Special Administrative Region of China (1654), Macao Special Administrative Region of China (1), Chinese Taipei (27), Colombia (1), France (6), Germany (8), Italy (1), Kuwait (1), Malaysia (7), Mongolia (9), Philippines (10), Republic of Ireland (1), Republic of Korea (1), Romania (1), Singapore (204), South Africa (1), Spain (1), Sweden (3), Switzerland (1), Thailand (7), United Kingdom (6), United States (65), Viet Nam (63). In order to see further details, including cumulative number of cases
and deaths, please visit the following URL: For the full WHO travel advisory, together with additional information about this disease, please visit the following URL: http://www.who.int/csr/sars/en/ For information from CDC including guidelines and recommendations, please
visit the following URL: For information from Department of Health Hong Kong SAR, please visit
the following URL: For information from Singapore Ministry of Health, please visit the
following URL: China (Liaoling) — Investigation Results of Milk Poisoning Case The experts determined that some kind of trypsin inhibitor in the soy
milk was the cause of the accident, and people allergic to the agent
would suffer digestive tract problems after consuming the soy milk. They
also ruled out the possibility of bacterial, chemical, and animal poisons. As of the evening of Apr. 15, 2003, 84 pupils had been under treatment
in 3 local hospitals. (ProMed 4/20/03) Dr. Carlo Urabani, a dedicated and internationally respected Italian epidemiologist, he died at age of 46 in Bangkok from SARS, the new disease that he had helped to identify. “His wife Giuliana told me that a few days before falling ill he had argued with her. She was concerned to see him working with patients with such a deadly disease. He said: "If I cannot work in such situations, what am I here for — answering emails, going to cocktail parties, and pushing paper?" He is survived by his wife, sons Tommaso and Luca, and daughter Maddalena.” To see the entire obituary, please visit the following site: Second Leadership
Training on Gender, Sexuality and Sexual Health Center for Health Policy
Studies (Bangkok, Thailand from August 18 to September
5, 2003) The course is designed for people working with government and non–government organizations on sexual and reproductive health. This regional course aims to provide the participants with context–specific and gender–sensitive knowledge on sexuality and sexual health in Southeast Asia and China, while exploring relevant theoretical and methodological issues. Special attention will be devoted to exploring how conceptual and theoretical frameworks, especially gender and socio–cultural theories, can be applied to policy and interventions to enhance sexual and reproductive health in the region. Lecturers will include Dr. Pimpawun Boonmongkorn, Dr. Philip Guest, Prof. Irwan Hidayana, Dr. Le Minh Giang, Dr. Darwin Muhadjir and Dr. Michael Tan. For more information, contact the secretariat at: Center for Health Policy Studies Tel: 662𤮩�, 662𤮩� “CONTEXT: Severe acute respiratory syndrome (SARS) is an emerging
infectious disease that first manifested in humans in China in November
2002 and has subsequently spread worldwide.
OBJECTIVES: To describe the clinical characteristics and short–term
outcomes of SARS in the first large group of patients in North America;
to describe how these patients were treated and the variables associated
with poor outcome.
DESIGN, SETTING, and PATIENTS: Retrospective case series involving
144 adult patients admitted to 10 academic and community hospitals
in the greater Toronto, Ontario, area between March 7 and April 10,
2003, with a diagnosis of suspected or probable SARS. Patients were
included if they had fever, a known exposure to SARS, and respiratory
symptoms or infiltrates observed on chest radiograph. Patients were
excluded if an alternative diagnosis was determined.
MAIN OUTCOME MEASURES: Location of exposure to SARS; features of the
history, physical examination, and laboratory tests at admission to
the hospital; and 21–day outcomes such as death or intensive care unit
(ICU) admission with or without mechanical ventilation.
RESULTS: Of the 144 patients, 111 (77%) were exposed to SARS in the
hospital setting. Features of the clinical examination most commonly
found in these patients at admission were self–reported fever (99%),
documented elevated temperature (85%), nonproductive cough (69%), myalgia
(49%), and dyspnea (42%). Common laboratory features included elevated
lactate dehydrogenase (87%), hypocalcemia (60%), and lymphopenia (54%).
Only 2% of patients had rhinorrhea. A total of 126 patients (88%) were
treated with ribavirin, although its use was associated with significant
toxicity, including hemolysis (in 76%) and decrease in hemoglobin of
2 g/dL (in 49%). Twenty–nine patients (20%) were admitted to the ICU
with or without mechanical ventilation, and 8 patients died (21–day
mortality, 6.5%; 95% confidence interval [CI], 1.9%㪣.8%). Multivariable
analysis showed that the presence of diabetes (relative risk [RR],
3.1; 95% CI, 1.4ף.2; P =.01) or other comorbid conditions (RR, 2.5;
95% CI, 1.1ס.8; P =.03) were independently associated with poor outcome
(death, ICU admission, or mechanical ventilation).
CONCLUSIONS: The majority of cases in the SARS outbreak
in the greater Toronto area were related to hospital exposure. In the
event that contact
history becomes unreliable, several features of the clinical presentation
will be useful in raising the suspicion of SARS. Although SARS is Comparative full–length genome sequence analysis of 14 SARS coronavirus
isolates and common mutations associated with putative origins of
infection “Background: The cause of severe acute respiratory syndrome
(SARS) has been identified as a new coronavirus. Whole genome sequence
analysis of various isolates might provide an indication of potential
strain differences of this new virus. Moreover, mutation analysis will
help to develop effective vaccines.
Methods: We sequenced the entire SARS viral genome of cultured isolates
from the index case (SIN2500) presenting in Singapore, from three primary
contacts (SIN2774, SIN2748, and SIN2677), and one secondary contact
(SIN2679). These sequences were compared with the isolates from Canada
(TOR2), Hong Kong (CUHK–W1, and HKU39849), Hanoi (URBANI), Guangzhou
(GZ01), and Beijing (BJ01, BJ02, BJ03, BJ04).
Findings: We identified 129 sequence variations among the 14 isolates,
with 16 recurrent variant sequences. Common variant sequences at four
loci define two distinct genotypes of the SARS virus. One genotype
was linked with infections originating in Hotel M in Hong Kong, the
second contained isolates from Hong Kong, Guangzhou, and Beijing with
no association with Hotel M (p<0•0001). Moreover, other common
sequence variants further distinguished the geographical origins of
the isolates, especially between Singapore and Beijing.
Interpretation: Despite the recent onset of the SARS epidemic, genetic
signatures are emerging that partition the worldwide SARS viral isolates
into groups on the basis of contact source history and geography. These
signatures can be used to trace sources of infection. In addition,
a common variant associated with a non–conservative aminoacid change
in the S1 region of the spike protein, suggests that immunological
pressures might be starting to influence the evolution of the SARS
virus in human populations.” Below is the commentary on the above Ruan’s article. Clinical progression and viral load in a community outbreak of coronavirus–associated
SARS pneumonia: a prospective study “Background: We investigated the temporal progression of the
clinical, radiological, and virological changes in a community outbreak
of severe acute respiratory syndrome (SARS).
Methods: We followed up 75 patients for 3 weeks managed with a standard
treatment protocol of ribavirin and corticosteroids, and assessed the
pattern of clinical disease, viral load, risk factors for poor clinical
outcome, and the usefulness of virological diagnostic methods.
Findings: Fever and pneumonia initially improved
but 64 (85%) patients developed recurrent fever after a mean of 8•9
(SD 3•1)
days, 55 (73%) had watery diarrhoea after 7•5 (2•3) days,
60 (80%) had radiological worsening after 7•4 (2•2) days,
and respiratory symptoms worsened in 34 (45%) after 8•6 (3•0)
days. In 34 (45%) patients, improvement of initial pulmonary lesions
was associated with appearance of new radiological lesions at other
sites. Nine (12%) patients developed spontaneous pneumomediastinum
and 15 (20%) developed acute respiratory distress syndrome (ARDS) in
week 3. Quantitative reverse–transcriptase (RT) PCR of nasopharyngeal
aspirates in 14 patients (four with ARDS) showed peak viral load at
day 10, and
at day 15 a load lower than at admission. Age and chronic
hepatitis B virus infection treated with lamivudine were independent
significant risk factors for progression to ARDS (p=0•001). SARS–associated
coronavirus in faeces was seen on RT–PCR in 65 (97%) of 67 patients
at day 14. The mean time to seroconversion was 20 days.
Interpretation: The consistent clinical progression, shifting radiological
infiltrates, and an inverted V viral–load profile suggest that worsening
in week 2 is unrelated to uncontrolled viral replication but may be
related to immunopathological damage.” Risk of prevalent HIV infection associated with incarceration among
injecting “ OBJECTIVES: To identify risks for HIV infection related to
incarceration among injecting drug users in Bangkok, Thailand.
DESIGN: Case–control study of sexual and parenteral exposures occurring
before, during, and after the most recent incarceration.
SETTING: Metropolitan Bangkok.
PARTICIPANTS: Non–prison based injecting drug users formerly incarcerated
for at least six months in the previous five years, with documented
HIV serostatus since their most recent release; 175 HIV positive cases
and 172 HIV negative controls from methadone clinics.
MAIN OUTCOME MEASURE: Injection of heroin and methamphetamine, sharing
needles, sexual behavior, and tattooing before, during, and after incarceration.
RESULTS: In the month before incarceration cases were more likely
than controls to have injected methamphetamine and to have borrowed
needles. More cases than controls reported using drugs (60% v 45%;
P=0.005) and sharing needles (50% v 31%; P<0.01) in the holding
cell before incarceration. Independent risk factors for prevalent HIV
infection included injection of methamphetamine before detention (adjusted
odds ratio 3.3, 95% confidence interval 1.01 to 10.7), sharing needles
in the holding cell (1.9, 1.2 to 3.0), being tattooed while in prison
(2.1, 1.3 to 3.4), and borrowing needles after release (2.5, 1.3 to
4.4).
CONCLUSIONS: Injecting drug users in Bangkok are at significantly
increased risk of HIV infection through sharing needles with multiple
partners while in holding cells before incarceration. The time spent
in holding cells is an important opportunity to provide risk reduction
counseling and intervention to reduce the incidence of HIV.”
2. JOIN THE E–LIST AND RECEIVE EINet NEWS BRIEFS REGULARLY The APEC EINet listserv was established to enhance collaboration among academicians and public health professionals in the area of emerging infections surveillance and control. Subscribers are encouraged to share their material with colleagues in the Asia–Pacific Rim. To subscribe (or unsubscribe), contact apec–ein@u.washington.edu. Further information about the APEC Emerging Infections Network is available at http://www.apec.org/infectious. |
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© 2003, The University of Washington |
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